Early retirement and the influence on healthcare budgets and insurance premiums in a diabetes population

Figures & data

Table 1 Base assumptions for the three budget impact scenarios

Parameter	Base case scenario	Best case scenario	Worst case scenario
Average yearly income (€)a	35,517	35,517	35,517
Average yearly income lost due to early retirement (€)	14,207	14,207	14,207
Retirement rate for current Tx (%)	5.0	5.0	5.0
Retirement rate for current Tx and new option (%)	5.0	2.5	7.5
Premium (percentage of yearly income)a	14.0	14.0	14.0
Covered population - in both arms	83,000,000	83,000,000	83,000,000
Number of treated patientsa	107,070	107,070	107,070
Prevalence (%)a	6.45	6.45	6.45
Incidence per year	1,000	500	2,000

a in the “Current Tx” and “Current Tx & NEW option” arm.

Table 2 Diabetes-related complication costs derived from literature

Cost item	Costs per event (€)	Source
Hypoglycemia	384	Diabetes Care 1995
Retinopathy/Macular edema	71	O’Brien et al 1998
Blindness in one eye	4365	O’Brien et al 1998
Cataract	2250	Internal expert assumption
Micro-/Macroalbuminuria	78	O’Brien et al 1998
End-stage renal disease	77,735	O’Brien et al 1998
Neuropathy	273	O’Brien et al 1998
Peripheral arterial disease	6867	DRG handbook 2000
Diabetic foot syndrome	3421	O’Brien et al 1998
Myocardial infarction	34,597	O’Brien et al 1998
Heart failure	12,038	DRG handbook 2000
Angina pectoris	3102	O’Brien et al 1998
Stroke	50,858	O’Brien et al 1998

Table 3 Cumulative diabetes complication rates derived from UKPDS (1998) for the world with and without the new option (“Current treatment” vs “Current treatment & NEW option”). The complication rates are reported for the hypothetical diabetes cohort of 107,070 at year 0 (see assumptions)

Complication	“Current treatment”
	Year 1	Year 2	Year 3	Year 4	Year 5	Year 6	Year 7	Year 8	Year 9	Year 10
Hypoglycemia	2478	5274	7257	8861	10,060	11,087	11,782	12,331	12,772	10,649
Ophthalmic disorders (retinopathy, macular edema, blindness, cataract)	12,376	23,052	31,963	39,641	46,598	52,785	58,389	63,589	68,376	72,850
Kidney system, (Micro-, macroalbuminuria, end-stage renal disease)	4835	9460	14,175	18,373	22,431	26,438	30,321	33,827	37,141	39,842
Nerve system (neuropathy, peripheral arterial disease, diabetic foot syndrome)	4613	9042	13,571	18,124	22,578	26,874	30,963	35,442	40,158	44,560
Cardiovascular system	3094	58839	8651	11,365	14,038	16,619	19,142	21,398	23,713	26,014
Mortality	5845	11,442	16,574	21,279	25,920	30,118	34,032	37,834	41,378	44,782
Complication	“Current treatment”
	Year 1	Year 2	Year 3	Year 4	Year 5	Year 6	Year 7	Year 8	Year 9	Year 10
Hypoglycemia	2831	5092	6999	8688	9876	10,945	11,672	12,279	12,915	13,387
Ophthalmic disorders (retinopathy, macular edema, blindness, cataract)	11,513	21,403	29,638	36,704	43,064	48,508	53,467	58,008	62,184	66,029
Kidney system (Micro-, macroalbuminuria, end-stage renal disease)	4460	8687	12996	16872	20,596	24,244	27,787	30,993	34,047	36,536
Nerve system (neuropathy, peripheral arterial disease, diabetic foot syndrome)	4286	8348	12,423	16,517	20,489	24,283	27,819	31,706	35,773	39,509
Cardiovascular system	2931	5564	8180	10,722	13,251	15,717	18,076	20,173	22,303	24,419
Mortality	5484	10,732	15,519	19,979	24,438	28,395	32,121	35,824	39,304	42,625

Table 4 Market share for the three possible treatments over time for the three budget impact scenarios

Market share share	Current market share	Target market share (Base / Best / Worst)	Time to reach the target
Insulin: Current Txa	38	40	1
OADs: Current Txa	62	60	1
Insulin: Current Tx + new option	38	45 / 30 / 50	4
OADs: Current Tx + new option	62	10 / 0 / 31	8
New option	0	45 / 70 / 19	8

a Assumption: fixed market in terms of scenarios.

Table 5 Yearly drug costs (€) for the three pharmaceutical treatment options on the market

Cost item (€; yearly)	Base case scenario	Best case scenario	Worse case scenario
Insulin	286	286	286
Oral antidiabetics (OADs)	89	89	89
New option	1,000	500	1,500

Table 6 Budget Impact and premium differences for the three scenarios (base, best worse case) and for the corresponding (new option) cost groups for the incidence group 1000 patients per year. Budget Impact as well as premium differences are “Current Tx” vs “Current Tx & NEW”

Incidence per year: 1,000	Year 1	Year 2	Year 3	Year 4	Year 5	Year 6	Year 7	Year 8	Year 9	Year 10
New option costs: €500
Budget Impact: Base Case	8,8847,518	14,172,088	24,553,377	36,123,442	44,348,912	49,426,880	60,670,863	70,756,833	85,102,459	99,108,673
Budget Impact: Best Case	4,968,733	5,573,514	12,102,680	20,062,508	24,303,277	25,193,357	32,636,192	38,612,245	49,164,357	58,860,034
Budget Impact: Worse Case	7,117,511	12,480,246	20,742,754	29,663,493	36,593,758	41,611,688	50,223,934	58,257,157	68,769,327	79,312,377
Premium difference (%): Base Case	0.0013 (0.1)	0.0028 (1.8)	0.0045 (2.9)	0.0059 (3.7)	0.0071 (4.4)	0.0082 (5.1)	0.0089 (5.7)	0.0091 (5.9)	0.0088 (6.0)	0.0085 (6.1)
Premium difference (%): Best Case	0.0024 (1.6)	0.0045 (3.0)	0.0068 (4.4)	0.0087 (5.5)	0.0103 (6.5)	0.0118 (7.5)	0.0127 (8.2)	0.0129 (8.6)	0.0126 (8.8)	0.0122 (8.9)
Premium difference (%): Worse Case	0.0001 (0.1)	0.0008 (0.5)	0.0016 (1.0)	0.0022 (1.3)	0.0027 (1.6)	0.0032 (2.2)	0.0036 (2.3)	0.0036 (2.3)	0.0035 (2.3)	0.0034 (2.3)
New option costs: €1,000
Budget Impact: Base Case	−11,008,614	−26,070,717	−36,652,501	−46,415,326	−59,806,876	−76,750,125	−88,377,410	−101,887,136	−112,177,201	−123,979,141
Budget Impact: Best Case	−28,738,462	−62,164,812	−89,744,421	−115,808,158	−145,612,915	−179,171,899	−207,231,445	−237,830,339	−265,435,969	−295,744,857
Budget Impact: Worse Case	−513,781	−2,483,397	−1,653,996	−279,004	−1,012,490	−3,858,233	−3,693,205	−4,510,308	−3,303,420	−2,494,335
Premium difference (%): Base Case	0.0013 (0.8)	0.0028 (1.8)	0.0045 (2.8)	0.0059 (3.6)	0.007 (4.3)	0.0081 (5.0)	0.0088 (5.6)	0.0089 (5.8)	0.0087 (5.9)	0.0084 (6.0)
Premium difference (%): Best Case	0.0023 (1.6)	0.0045 (2.9)	0.0068 (4.3)	0.0086 (5.4)	0.0102 (6.4)	0.0116 (7.4)	0.0125 (8.1)	0.0127 (8.5)	0.0125 (8.7)	0.0121 (8.8)
Premium difference (%): Worse Case	0.0001 (0.0)	0.0008 (0.5)	0.0015 (0.9)	0.0021 (1.3)	0.0026 (1.6)	0.0031 (1.9)	0.0034 (2.1)	0.0035 (2.2)	0.0034 (2.2)	0.0032 (2.2)
New option costs: €1500
Budget Impact: Base Case	−30,339,519	−65,342,035	−96,289,765	−126,743,112	−161,193,055	−199,692,095	−233,500,675	−269,927,604	−304,028,352	−340,790,018
Budget Impact: Best Case	−61,920,432	−128,931,651	−190,022,909	−249,467,842	−312,759,498	−380,302,119	−443,174,072	−509,669,424	−574,607,786	−644,072,811
Budget Impact: Worse Case	−7,619,847	−16,475,553	−22,482,132	−28,010,518	−35,849,128	−46,093,119	−53,685,334	−62,674,272	−69,947,658	−78,024,111
Premium difference (%): Base Case	0.0013 (0.9)	0.0028 (1.8)	0.0045 (2.8)	0.0059 (3.6)	0.007 (4.3)	0.0081 (5.0)	0.0088 (5.6)	0.0089 (5.8)	0.0087 (5.9)	0.0084 (6.0)
Premium difference (%): Best Case	0.0023 (1.6)	0.0045 (2.9)	0.0068 (4.3)	0.0086 (5.4)	0.0102 (6.4)	0.0116 (7.4)	0.0125 (8.1)	0.0127 (8.5)	0.013 (8.7)	0.0121 (8.8)
Premium difference (%): Worse Case	0.0001 (0.0)	0.0008 (0.9)	0.0015 (0.9)	0.0021 (1.3)	0.0026 (1.6)	0.0032 (1.9)	0.0034 (2.1)	0.0035 (2.2)	0.0034 (2.2)	0.0032 (2.2)

Table 7 Budget Impact and premium differences for the three scenarios (base, best worse case) and for the corresponding (new option) cost groups for the incidence group 500 patients per year. Budget Impact as well as premium differences are “Current Tx” vs “Current Tx & NEW”

Incidence per year: 500	Year 1	Year 2	Year 3	Year 4	Year 5	Year 6	Year 7	Year 8	Year 9	Year 10
New option costs: €500
Budget Impact: Base Case	8,322,292	13,200,602	22,984,763	33,912,459	41,579,302	46,191,844	56,745,854	66,153,332	79,673,949	92,831,737
Budget Impact: Best Case	4,602,027	4,602,027	10,534,066	17,851,526	21,533,668	21,958,321	28,711,182	34,008,745	43,735,848	52,583,097
Budget Impact: Worse Case	6,592,285	11,508,759	19,174,141	27,452,510	33,824,149	38,376,653	46,298,925	53,653,656	63,340,817	73,035,440
Premium difference (%): Base Case	0.0013 (0.9)	0.0028 (1.8)	0.0045 (2.8)	0.0059 (3.6)	0.007 (4.3)	0.0081 (5.0)	0.0088 (5.6)	0.0089 (5.8)	0.0087 (5.9)	0.0084 (6.0)
Premium difference (%): Best Case	0.0023 (1.6)	0.0045 (2.9)	0.0068 (4.3)	0.0086 (5.4)	0.0102 (6.4)	0.0116 (7.4)	0.0127 (8.1)	0.0127 (8.5)	0.0125 (8.7)	0.0121 (8.8)
Premium difference (%): Worse Case	0.0001 (0.0)	0.0008 (0.5)	0.0015 (0.9)	0.0021 (1.3)	0.0026 (1.6)	0.0031 (1.9)	0.0034 (2.1)	0.0035 (2.2)	0.0034 (2.2)	0.0032 (2.2)
New option costs: €1,000
Budget Impact: Base Case	−11,008,614	−26,002,120	−36,453,342	−46,000,992	−58,886,072	−74,875,789	−85,752,481	−98,107,186	−107,540,589	−118,061,822
Budget Impact: Best Case	−28,738,462	−62,009,423	−89,219,944	−114,620,480	−143,187,163	−174,725,971	−200,609,303	−228,166,314	−252,589,238	−278,662,119
Budget Impact: Worse Case	−513,781	−2,475,995	−1,671,224	−372,342	−1,138,886	−3,899,416	−3,928,150	−4,886,497	−4,197,019	−3,927,155
Premium difference (%): Base Case	0.0013 (0.9)	0.0028 (1.8)	0.0046 (2.8)	0.0061 (3.7)	0.0076 (4.4)	0.0092 (5.3)	0.0104 (6.0)	0.0111 (6.4)	0.0115 (6.6)	0.0117 (6.8)
Premium difference (%): Best Case	0.0023 (1.6)	0.0045 (2.9)	0.0069 (4.3)	0.009 (5.5)	0.011 (6.6)	0.013 (7.7)	0.0148 (8.7)	0.0158 (9.3)	0.0164 (9.7)	0.0167 (10.0)
Premium difference (%): Worse Case	0.0001 (0.0)	0.0008 (0.5)	0.0016 (0.9)	0.0022 (1.3)	0.0028 (1.6)	0.0036 (2.0)	0.0041 (2.3)	0.0044 (2.4)	0.0046 (2.5)	0.0046 (2.6)
New option costs: €1,500
Budget Impact: Base Case	−30,339,519	−65,176,386	−95,691,990	−125,316,374	−158,228,845	−194,222,406	−225,112,588	−257,516,882	−287,111,454	−318,067,899
Budget Impact: Best Case	−61,920,432	−128,613,390	−188,842,320	−246,641,851	−307,072,176	−370,175,648	−427,511,437	−486,532,420	−542,643,841	−600,872,385
Budget Impact: Worse Case	−7,619,847	−16,434,486	−22,363,688	−27,761,139	−35,280,174	−44,879,832	−51,912,247	−60,000,445	−66,465,838	−73,438,798
Premium difference (%): Base Case	0.0013 (0.9)	0.0028 (1.8)	0.0046 (2.8)	0.0061 (3.7)	0.0076 (4.4)	0.0092 (5.3)	0.0104 (6.0)	0.0111 (6.4)	0.0115 (6.6)	0.0117 (6.8)
Premium difference (%): Best Case	0.0023 (1.6)	0.0045 (2.9)	0.0069 (4.3)	0.009 (5.5)	0.1104 (6.6)	0.0131 (7.7)	0.0148 (8.7)	0.0158 (9.3)	0.0164 (9.7)	0.0167 (10.0)
Premium difference (%): Worse Case	0.0001 (0.0)	0.0008 (0.5)	0.0016 (0.9)	0.0022 (1.3)	0.0028 (1.6)	0.0036 (2.0)	0.0041 (2.3)	0.0044 (2.4)	0.0046 (2.5)	0.0046 (2.6)

Table 8 Budget Impact and premium differences for the three scenarios (base, best worse case) and for the corresponding (new option) cost groups for the incidence group 2,000 patients per year. Budget Impact as well as premium differences are “Current Tx” vs “Current Tx & NEW”

Incidence per year: 2000	Year 1	Year 2	Year 3	Year 4	Year 5	Year 6	Year 7	Year 8	Year 9	Year 10
New option costs: €500
Budget Impact: Base Case	8,322,292	13,257,513	23,383,676	35,108,597	43,824,505	49,633,878	63,022,311	75,854,974	94,961,295	114,606,698
Budget Impact: Best Case	4,443,507	4,616,994	10,797,333	18,752,795	23,205,302	24,427,551	33,547,884	41,626,652	56,276,813	70,652,998
Budget Impact: Worse Case	6,592,285	11,561,286	19,479,943	28,324,620	35,467,645	40,931,960	50,784,880	60,506,065	73,878,853	87,937,344
Premium difference (%): Base Case	0.0013 (0.9)	0.0028 (1.8)	0.0043 (2.8)	0.0053 (3.5)	0.006 (4.1)	0.0065 (4.6)	0.0066 (5.0)	0.0062 (5.1)	0.0057 (5.0)	0.0051 (5.0)
Premium difference (%): Best Case	0.0023 (1.6)	0.0044 (2.9)	0.0065 (4.2)	0.0079 (5.3)	0.0088 (6.1)	0.0094 (6.9)	0.0095 (7.3)	0.009 (7.5)	0.0082 (7.4)	0.0074 (7.4)
Premium difference (%): Worse Case	0.0001 (0.0)	0.0007 (0.5)	0.0014 (0.9)	0.0019 (1.2)	0.0022 (1.4)	0.0025 (1.7)	0.0025 (1.9)	0.0024 (1.9)	0.0021 (1.8)	0.0019 (1.8)
New option costs: €1,000
Budget Impact: Base Case	−11,008,614	−26,002,120	−36,453,342	−46,000,992	−58,886,072	−74,875,789	−85,752,481	−98,107,186	−107,540,589	−118,061,822
Budget Impact: Best Case	−28,738,462	−62,009,423	−89,219,944	−114,620,480	−143,187,163	−174,725,971	−200,609,303	−228,166,314	−252,589,238	−278,662,119
Budget Impact: Worse Case	−513,781	−2,475,995	−1,671,224	−372,342	−1,138,886	−3,899,416	−3,928,150	−4,886,497	−4,197,019	−3,927,155
Premium difference (%): Base Case	0.0013 (0.9)	0.0028 (1.8)	0.0046 (2.8)	0.0061 (3.7)	0.0076 (4.4)	0.0092 (5.3)	0.0104 (6.0)	0.0111 (6.4)	0.0115 (6.6)	0.0117 (6.8)
Premium difference (%): Best Case	0.0023 (1.6)	0.0045 (2.9)	0.0069 (4.3)	0.009 (5.5)	0.011 (6.6)	0.0131 (7.7)	0.0148 (8.7)	0.0158 (9.3)	0.0164 (9.7)	0.0167 (10.0)
Premium difference (%): Worse Case	0.0001 (0.0)	0.0016 (0.9)	0.0022 (1.3)	0.0028 81.6)	0.0036 (2.0)	0.0041 (2.3)	0.0044 (2.3)	0.0044 (2.4)	0.0046 (2.5)	0.0046 (2.6)
New option costs: €1,500
Budget Impact: Base Case	−30,339,519	−65,176,386	−95,691,990	−125,316,374	−158,228,845	−194,222,406	−225,112,588	−257,516,882	−287,111,454	−318,067,899
Budget Impact: Best Case	−61,920,432	−128,613,390	−188,842,320	−246,641,852	−307,072,176	−370,175,648	−427,511,437	−486,511,437	−542,643,841	−600,872,385
Budget Impact: Worse Case	−7,920,432	−16,434,486	−22,363,688	−27,761,139	−35,280,174	−44,897,832	−51,912,247	−60,000,445	−66,465,838	−73,438,798
Premium difference (%): Base Case	0.0013 (0.9)	0.0028 (1.8)	0.0046 (2.8)	0.0061 (3.7)	0.0076 (4.4)	0.0092 (5.3)	0.0104 (6.0)	0.0111 (6.4)	0.0115 (6.6)	0.0117 (6.8)
Premium difference (%): Best Case	0.0023 (1.6)	0.0045 (2.9)	0.0069 (4.3)	0.009 (5.5)	0.011 (6.6)	0.0131 (7.7)	0.0148 (8.7)	0.0158 (9.3)	0.0164 (9.7)	0.0167 (10.0)
Premium difference (%): Worse Case	0.0001 (0.0)	0.0008 (0.5)	0.0016 (0.9)	0.0022 (1.3)	0.0028 (1.6)	0.0036 (2.0)	0.0041 (2.3)	0.0044 (2.4)	0.0046 (2.5)	0.0046 (2.6)

O’BrienAShompheLAKavanaghPLDirect medical costs of complications resulting from type 2 diabetes in the USDiabetes Care199821112289653606

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[UKPDS] Prospective Diabetes Study GroupIntensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)Lancet1998352837539742976

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